My patient has an ICDSC of 4. Does this mean that he has delirium?
Maybe, or maybe not.
No screening tool is 100% sensitive nor 100% specific. A specific tool is very good at detecting delirium if the patient has delirium. A specific tool is one that does not detect delirium if the patient doesn't have delirium.
If a patient has an ICDSC of 4 or greater, the patient has "screened positive" for delirium. A positive screen is suggestive of delirium, however, all tools can have false positives.
The diagnosis of delirium is made by the physician following a clinical examination.
My patient has an ICDSC of 8. Is he more delirious than a patient whose ICDSC is 4?
The ICDSC screen is dicotomous, meaning, you have either screened positive or negative. The tool does not measure the degree of delirium, therefore, a higher score does not necessarily indicate the degree of delirium.
My patient has screened positive using the ICDSC. What should we do first?
The physician should be notified that the patient has screened positive and a clinical examination should be performed. Delirium is a clinical diagnosis; it is not based soley on the screening results.
Any patient who experiences behavioural changes should be evaluated for possible life threatening causes, such as inadequate ABCs or blood sugar or a neurological event. Delirium will not cause focal findings, CT changes or seizures.
The cause or risk factors for delirium should be investigated and treated. For example, sepsis, metabolic disturbances or the use of deliriogenic medications should be considered and treated if required. Alcohol withdrawal, constipation and pain are other examples of treatable risk factors.
Antipscyhotic medications may be ordered following clinical assessment.
